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Arthroscopy. 2016 Jan;32(1):165-75. doi: 10.1016/j.arthro.2015.06.049. Epub 2015 Sep 15.

The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review.

Author information

1
Research Center Linnaeus Institute, Spaarne Hospital, Hoofddorp, Netherlands; Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands. Electronic address: jlouwerens@spaarneziekenhuis.nl.
2
Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
3
Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands.

Abstract

PURPOSE:

The objectives of this comprehensive quantitative review of the treatment of calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery.

METHODS:

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit.

RESULTS:

Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered.

CONCLUSIONS:

Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear.

LEVEL OF EVIDENCE:

Level IV, systematic review of Level I, II, and IV studies.

PMID:
26382637
DOI:
10.1016/j.arthro.2015.06.049
[Indexed for MEDLINE]

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